|Year : 2017 | Volume
| Issue : 1 | Page : 6-10
Trends in mandibular fractures: A comparison of two cohorts of patients in the same institution 10 years apart
Charles E Anyanechi1, Felix N Chukwuneke2
1 Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
2 Department of Oral and Maxillofacial Surgery, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
|Date of Web Publication||7-Jun-2017|
Charles E Anyanechi
Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Eastern Highway, 540001 Calabar
Source of Support: None, Conflict of Interest: None
Background: The fractures of the mandible are common facial injuries, and their consequences have remained a burden in dental and oral surgery practice. To review patients with mandibular fractures at our institution over a 4-year time frame of 10 years apart between 1997–2000 and 2011–2014 and compare the trends in the number of cases.
Materials and Methods: The hospital register and case notes of the patients with mandibular fractures were retrospectively reviewed to obtain relevant information concerning the socio-demographic data and clinical characteristics of the fractures.
Results: There was a reduction in the number of patients and fractures when the 2011 study (168 patients and 239 fractures) was compared with the 1997 study (358 patients and 474 fractures), and this was significant (P = 0.001). Road traffic accidents were the most common cause of fractures; motorcycle-related traffic accidents were more frequent in the years 1997–2000 (n = 128, 35.7%) than that in the years 2011–2014 (n = 11, 6.6%); vehicular road traffic accidents were more common in the years 2011–2014 (n = 123, 73.2%) than that in the years 1997–2000 (n = 153, 42.7%), and these were significant (P = 0.001). Mandibular fractures were more of isolated fractures and less associated with concomitant injuries in the 2011 study than that in the 1997 study (P = 0.001). There was a significant reduction of complications in the 2011 study (P = 0.001).
Conclusion: This study has shown that the frequency of mandibular trauma has changed significantly over the past decade, which may be explained in terms of the ban on the use of motorcycle for public transportation.
Keywords: Cohorts, fractures, mandible, outcome assessment
|How to cite this article:|
Anyanechi CE, Chukwuneke FN. Trends in mandibular fractures: A comparison of two cohorts of patients in the same institution 10 years apart. J Med Trop 2017;19:6-10
|How to cite this URL:|
Anyanechi CE, Chukwuneke FN. Trends in mandibular fractures: A comparison of two cohorts of patients in the same institution 10 years apart. J Med Trop [serial online] 2017 [cited 2018 Mar 17];19:6-10. Available from: http://www.jmedtropics.org/text.asp?2017/19/1/6/207591
| Introduction|| |
The mandible is a prominent bone of the face, and fractures affecting it occur more frequently than those of the mid-facial bones., The frequency of mandibular fractures is high compared to similar injuries in other body areas because the face does not have much protective muscle covering that cushions it from direct trauma., According to some authors, the occurrence of mandibular fractures is always on the increase because of the fast pace of life, increased violence and advent of rapid modes of transportation., Direct trauma to the mandible due to road traffic accidents (RTAs), altercations, falls, gunshots, sporting injuries and industrial accidents have been reported as the leading causes., The literature suggests that although most authors agree that the rate of occurrence is high among males in their third decade of life, there have always been divergent views about the most common cause, site, type, the number of fractures and associated injuries involving these fractures., These findings may not be unrelated to the geographical variations, the lifestyle of the people and the place of study. However, earlier studies have shown that the characteristic presentation of mandibular fractures was influenced by the cultural and socio-economic life of the population studied.,,, The use of motorcycle for commercial transportation is common in Nigeria., However, knowledge of this study environment showed that the use of motorcycle for public transportation was common and popular until the government banned this means of transportation in November 2009 because of its high accident and crime rates involving the operators. Consequently, because we did not know any previous descriptive study comparing the occurrence of mandibular fractures in this environment, we undertook this study to compare two cohorts of patients and identify the trends in the number of cases in our institution. Therefore, the aim of this study was to compare and characterize two cohorts of patients with mandibular fractures within the same institution over two 4-year time frames, which were 10 years apart.
| Materials and methods|| |
Patients with mandibular fractures at the authors’ institution were retrospectively reviewed from 2011 to 2014, and a comparison was made with the authors’ experience from 1997 to 2000. The study was conducted at the Dental and Maxillofacial Surgery Clinic of our institution and was exempted from ethical clearance by the Research and Ethics Committee of this institution. Overall, 713 fractures in 526 patients diagnosed as mandibular fractures were studied; 474 fractures in 358 patients were recorded between 1997 and 2000, whereas in 2011–2014, 239 fractures in 168 patients were recorded. The hospital register and case notes of these patients were retrieved from the medical records department, analyzed and evaluated. Relevant information about the patients’ socio-demographic data and the clinical characteristics of mandibular fractures were noted. Information recorded included the data on age, sex, cause, site distribution, the number of fractures, associated injuries, treatment and complications. The data obtained were analyzed with EPI INFO 7 version 0.20, 2012 software package (CDC, Atlanta, GA, USA), and chi-squared (χ2) test was used to determine associations between variables at a 5% level of significance.
| Results|| |
The distribution of mandibular fractures according to age and sex in both groups is shown in [Figure 1]. The age of patients ranged from 7 to 59 years with a mean age of 29.9 ± 6.4 years in the 1997–2000 groups, whereas in the 2011–2014 groups, it ranged from 6 to 57 years with a mean of 28.7 ± 5.8 years. In both groups, the highest number of fractures occurred in the third decade of life and in those belonging to the male gender. There were 274 (76.4%) males and 84 (23.6%) females with a male-to-female ratio of 3.3:1 in the 1997–2000 group, whereas in the 2011–2014 group, there were 127 (75.6%) males and 41 (24.4%) females with a male-to-female ratio of 3.1:1. In all the age categories in both groups, there was male preponderance. The age and sex distribution within each group was found to be significant (P = 0.001), but was insignificant (P = 0.53) when both groups were compared.
|Figure 1: Distribution of age and gender of patients between 1997–2000 and 2011–2014|
Click here to view
The aetiological factors leading to fractures are presented in [Figure 2]. RTA was the most common cause of injury in both groups. Motorcycle-related traffic accident (MRTA) was more important as a cause in the 1997–2000 group (n = 128, 35.7%) than that in the 2011–2014 group (n = 11, 6.6%), whereas vehicular road traffic accident (VRTA) was more important in the 2011–2014 group (n = 123, 73.2%) than that in the 1997–2000 group (n = 153, 42.7%). All these were statistically significant (P = 0.001). This revealed a major difference in the mechanism of injury between the 1997 and 2011 studies, as MRTA decreased from 35.7% in the 1997 study to 6.6% in the 2011 study, whereas VRTA increased from 35.7% in the 1997 study to 73.2% in the 2011 study. The other aetiological factors identified in this study did not alter the trend of mandibular fractures studied. However, upon considering all the aetiological factors causing fractures in both groups, males outnumbered the females in all the categories. Furthermore, the result showed reduction in the number of patients and fractures when the 2011 study (168 patients and 239 fractures) was compared with the 1997 study (358 patients and 474 fractures), and this was statistically significant (P = 0.001). However, when the number of fractures was compared per patient, the 1997–2000 groups had an average of 1.3 fractures (474/358), whereas in the 2011–2014 groups, it was 1.4 (239/168), but this was not significant (P = 0.86).
[Table 1] shows the various sites of fractures in both groups; the body of the mandible was the most common site. In the 1997–2000 groups, mandibular fractures occurred as isolated injuries in 48 (13.4%) patients, whereas in 310 (86.6%) other patients, there were associated injuries [Table 2]. On the contrary, in the 2011–2014 groups, isolated fractures of the mandible occurred in 111 (46.3%) patients, whereas those fractures associated with other injuries were present in 128 (53.6%) patients. This showed that the mandibular fractures were more of isolated fractures and were less associated with concomitant injuries in the 2011 study than in the 1997 study, and this was significant (P = 0.001).
In the 1997–2000 groups, the methods of treatment employed to manage the fractures were conservative without active treatment in 37 patients (7.8%), closed reduction with inter-maxillary fixation (IMF) in 363 patients (76.6%) and open reduction with trans-osseous wiring and IMF in 74 patients (15.6%). Those in the 2011–2014 groups were also treated conservatively in 15 patients (6.3%), closed reduction with IMF in 181 patients (75.7%) and open reduction with trans-osseous wires and IMF in 43 patients (18.0%). There was no statistically significant (P = 0.54) difference in the methods of treatment employed in both studies. Following the treatment of fractures in the 1997–2000 groups, 9.9% (47/474) complications were recorded, whereas in the 2011–2014 groups, it was 5.0% (12/239). When the complications recorded [Table 3] in the two studies were compared, there was a significant difference (P = 0.001) in favour of the 2011 study.
| Discussion|| |
Although this study has shown that the pattern of occurrence of mandibular fractures with regard to age, sex and site distribution has not changed, there was a significant reduction in the number of patients, fractures, associated injuries and complications when the 2011 study was compared with the 1997 study, and in both groups, RTA was the most common cause of mandibular fractures. The decrease in patients and fractures is similar to what was recorded by Roode et al. but differs from that of Martinez et al., in which an increase in the number of patients and fractures was reported in the recent study than that in the previous study when two cohorts of patients were compared. This decrease was significantly because of the reduction of MRTAs resulting from the ban of the use of motorcycle for public transportation in this environment. Earlier studies in some cities have also shown a significant reduction in MRTA following the ban on the use of motorcycle for public transportation, although the injuries reported were not restricted to only those of the mandible as in this study., Furthermore, RTA was the most common aetiological factor in this study and was the leading cause for injuries in the report of Ongodia et al.; however, this was contrary to the report of Asadi and Asadi who reported altercation to be the most common cause. These findings buttress the reports made by earlier researchers that the prevalence of mandibular fractures differed from one locality to another and depends on the culture, lifestyle and socio-economic strata of the people under consideration.,
In both study groups, the body of the mandible was the most common site affected by the fractures. This is similar to earlier reports, but differs from the findings of Fridrich et al. and Ongodia et al., in which the angle and condyle respectively were the most common sites. It has been reported that the common sites of mandibular fractures depended on the mechanism of the injuring force.,,
The age and gender disposition of the patients in this study is in accordance with the reports in the literature.,, As in the previous reports,,, this study showed that mandibular fractures could occur in association with other injuries of the face and body. However, the fractures in our study were more of isolated fractures, and there were fewer concomitant injuries in the 2011 study than those in the 1997 study. This observation was partly due to a reduction in the number of patients and fractures in the 2011 study compared to the 1997 study.
The methods of treatment used to manage the fractures in both groups did not alter the treatment outcome, as they were the same and statistically insignificant (P = 0.54). These methods of treatment have been used by other researchers.,, However, rigid internal fixation if used would have given a better treatment outcome.,, When the complications recorded in the two studies were compared, there was a significant difference in favour of the 2011 study. This may be partly due to the less severity of the fractures, improved surgeons’ operating technique, better compliance to post-treatment instructions and a reduction in the number of patients and fractures in this group compared to the 1997 study.
| Conclusion|| |
This study has shown that the number of cases of mandibular trauma has changed significantly over the past decade in the authors’ institution. The ban on the use of motorcycle for public transportation may be a probable reason for the decrease in the number of patients and fractures sustained.
The authors appreciate the invaluable assistance rendered by Mrs. Ansa Ekpenyong of Dental Therapy Unit, Dept of Dental Surgery, University of Calabar Teaching Hospital Calabar, Nigeria during the course of execution of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Le BT, Dierks EJ, Ueeck BA, Homer LD, Potter BF. Maxillofacial injuries associated with domestic violence. J Oral Maxillofac Surg 2001;59:1277-83.
Banks P, Brown A. Fractures of the Facial Skeleton. 2nd ed. Oxford: Butterworth-Heinemann; 2001. p. 171-85.
Anyanechi CE. Mandibuar fractures associated with domestic violence in Calabar, Nigeria. Ghana Med J 2010; 44:155-8.
Rémi M, Christine MC, Gael P, Soizick P, Joseph-André J. Mandibular fractures in children: Long term results. Int J Pediatr Otorhinolaryngol 2003;67:25-30.
Malik NA. Textbook of Oral and Maxillofacial Surgery. 2nd ed. New Delhi: Jaypee Brothers; 2008. p. 315-413.
Roode GJ, Van Wyke PJ, Botha SJ. Mandibular fractures: An epidemiological survey at the Oral and Dental Hospital, Pretoria. SADJ 2007;62:272-4.
Asadi SG, Asadi Z. The aetiology of mandibular fractures at an urban centre. J R Soc Health 1997;117:164-7.
Emshoff R, Schöning H, Röthler G, Waldhart E. Trends in the incidence and cause of sports-related mandibular fractures: A retrospective analysis. J Oral Maxillofac Surg 1997;55:585-92.
Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: A review of 1,067 cases. J Oral Maxillofac Surg 1992;50:586-9.
Ongodia D, Li Z, Zhou H. Comparative analysis of trends in the treatment of mandibular fractures. J Oral Maxillofac Surg Med Pathol 2014;26:276-9.
Olubomehin OO. The development and impact of motorcycles as a means of commercial transportation in Nigeria. Res Hum Soc Sci 2012;2:231-40.
Ayanwuyi E. Rural dweller’s perception of impacts of motorcycle (okada) services in community development in Ogbomosho agricultural zone of Oyo state, Nigeria. Res Hum Soc Sci 2013;3:118-25.
Alt D, Chin V. Special correspondent: The strategy behind banning motorbikes in Calabar, Nigeria. Integrated Transport. The City Fix; March 24, 2010.
Martinez AY, Como JJ, Vacca M, Nowak MJ, Thomas CL, Claridge JA. Trends in maxillofacial trauma: A comparison of two cohorts of patients at a single institution 20 years apart. J Oral Maxillofac Surg 2014;72:750-4.
Asekhame FF, Oisamoje MD. Ban on commercial motorcycle operations in Benin City, Nigeria: An appraisal of the benefits and business opportunities. Dev Ctry Stud 2013;3:10-8.
Ikot AS, Akpan UU, Benson PJ, Etim OP. Motorcycle ban and its economic implications on Uyo Metropolis of Akwa Ibom state, Nigeria. Int J Econ Dev Res Inv 2011;2:32-9.
Moshy J, Mosha HJ, Lema PA. Prevalence of maxillomandibular fractures in mainland Tanzania. East Afr Med J 1996;73:172-5.
Bataineh AB. Aetiology and incidence of maxillofacial fractures in the North of Jordan. Oral Surg Oral Med Oral Pathol Radiol Endod 1998;86:31-5.
Saheed BD, Etafia MO. Influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes. West Afr J Med 2003;12:146-9.
Tanaka N, Tomitsuka K, Shionoya K, Andou H, Kimijima Y, Tashiro T et al.
Aetiology of maxillofacial fractures. Br J Oral Maxillofac Surg 1994;32:19-23.
Kyzas PA, Saeed A, Tabbenor O. The treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg 2012;40:e438-52.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]